Prof. Nevzat Tarhan: “There should be no hopelessness in a physician’s vocabulary”

President of Üsküdar University, Psychiatrist Prof. Nevzat Tarhan, met with physicians and healthcare professionals at Gölcük Necati Çelik State Hospital. In his talk titled “Communication Accidents,” Tarhan shared striking insights on the place and importance of communication, particularly in healthcare and in life in general. Referring to methods of coping with difficult personalities, he emphasized the necessity of an empathy-based approach. He stated that proper role distribution and establishing open, trust-based communication are decisive factors in professional relationships for healthy communication. He underlined that unresolved emotional conflicts may, over time, manifest as physical outcomes, and stressed that hopelessness should not exist in a physician’s vocabulary.

The talk was held in the Conference Hall of Gölcük Necati Çelik State Hospital.

The session was moderated by journalist Şaban Özdemir.

“Communication is important not only in healthcare but also in life”

Addressing the decisive role of communication in social life, Psychiatrist Prof. Nevzat Tarhan said, “Communication is important not only in healthcare but also in life. Unlike other animal offspring, the human child is born premature in terms of communication. In other words, a human being is born psychologically premature. For example, a duck knows how to swim as soon as it hatches from the egg. A baby giraffe is born, shakes itself once or twice, and immediately begins to walk. A human child can only walk after about a year and can distinguish right from wrong at the age of fifteen. That means all of a person’s social, emotional, and communication skills are learned later. A person learns them in the environment into which they are born, and communication is acquired afterward. This also applies in the field of healthcare. In family relationships, in marital relationships, in relationships with children, in short in all social life, communication is decisive.”

Emotional transmission is important

Stating that communication has two types, verbal and non-verbal, Tarhan said, “Verbal communication consists of the words we use and accounts for approximately twenty percent of communication. Eighty percent of communication is non-verbal communication, including tone of voice, subtle emphases, facial expressions, gestures, body language, and the words chosen. All of these constitute a major part of communication and create an emotional transmission in the other person. Communication that involves emotional transmission is not the same as communication that involves only verbal transmission. Emotional transmission occurs entirely through an unconscious mechanism, without our awareness. Our sincerity becomes visible there, and our transparency is understood.”

Toxic dark forces

In the talk, where questions from participants were also addressed, Tarhan discussed difficult personalities and said, “There is a concept called the Dark Triad. It consists of narcissistic personality, Machiavellian personality, and antisocial personality. These are the toxic dark triad. A person who carries these three traits is like a tumor or a cancer cell. A cancer cell grows limitlessly, irresponsibly, and insatiably. It says, ‘all for me’ and consumes the tissues next to it. It uses most of the glucose that enters the body. It does not think about whether the body will die or not; it just keeps growing. If it starts in the liver, the person may die from liver failure, but it never considers that. Similarly, there are toxic personalities in communication. We define these as difficult personalities. It is necessary to recognize them and develop the right attitude toward them. In interactions with people who come to the hospital, communication has three pillars. One is healthy communication, the second is conflictual communication, and the third is lack of communication. The worst is lack of communication. Not responding at all arouses greater anger than saying a harsh word to the other person. Because it implies that they are worthless, it ignores them. One of the greatest psychological needs of a human being is the need for existence. Ignoring a person is one of the greatest harms that can be done to them. Therefore, lack of communication produces more severe consequences than conflictual communication. Even in a quarrel there is communication; the person is being addressed and is given some value, even if negative. But in lack of communication no value is given; one stands like a wall in front of the other. This is called stonewalling behavior. When this is done, the other party reacts much more strongly.”

“Those who manage role distribution well minimize communication accidents”

Emphasizing that role distribution must be fair, Tarhan said, “At the Faculty of Medicine, we teach clinical communication to medical students. We study clinical communication, but this is not limited to the relationship between healthcare worker and patient. It also includes horizontal relationships within teamwork, horizontal and vertical relationships, and relationships established with outsiders and patients’ relatives. In business relationships there is a concept called the internal customer. That means the people one works with inside the organization. They are human too; they have emotions and traumas. When approaching them, one must not forget this: every person is worthy of respect, every person is unique. Titles are especially valuable in Eastern societies. In Western societies, titles and personalities are not mixed as much. Professional ethics has taught them this. A person who manages role distribution well minimizes communication accidents. At this moment I am in the role of a physician, a nurse, a clinician, but when I go home, I must leave that role and move into the role of father or mother. If you encounter a patient outside, you should no longer behave in that professional role. A person who can do this manages role distribution correctly. Therefore, we need to define professional and social roles well and develop correct models for them in our minds.”

“Intentional and unintentional behavior operate through different mechanisms in the brain”

Stating that categorical thinking should be applied, Tarhan said, “Intentional behavior and unintentional behavior operate through different mechanisms in the brain. This is called categorical thinking. A person is in the role of father at home, in the role of employer or employee at work. If one intends this, the brain takes a position related to that role, builds its perception accordingly, and develops responses accordingly. For example, everyone has some trouble, perhaps a sick child at home or another problem. They come here. When they arrive, they should say to themselves: In the past, communication experts would say, ‘act the role even if you do not feel like it.’ But if a person does not genuinely believe in the role, this will not be reflected in emotional transmission. It will not be reflected in non-verbal communication either. Without realizing it, when saying ‘Here you are,’ they may extend something harshly, almost as if throwing it. This happens because they have not internalized the role. If the person says, ‘Yes, I have many problems at home. I need to solve them, but right now I am in my professional role. I have noted these issues, and I will deal with them in the evening,’ this is categorical thinking. It is the same in our profession. As clinicians, we listen every day to dozens of problematic, troubled, distressing stories. If we listen to one and move on to another while our mind remains with the previous patient, it is impossible to do this job. When each patient comes, one must address the issue related to that patient, make a summary, place it on a mental shelf, and then move on to the next patient. This is called categorical thinking and strategic thinking in the brain. In strategic thinking, a person has a goal and determines a strategy related to that goal. Of course, purpose and meaning are very important here.”

“Starting with ‘The final decision is yours’ is very effective”

Discussing how the relationship between patient and physician should be structured, Tarhan said, “Before coming to the doctor, people now definitely search on Google or ask artificial intelligence. They come with a lot of information. Much of it is almost like hallucinations, fabricated and not real. Correcting and persuading them is truly very difficult. In such cases, I sometimes say to insistent patients, ‘What is your profession?’ For example, they say, ‘I am an engineer.’ I respond, ‘Look, I do not understand engineering, and you do not understand medicine.’ I say, ‘This is my opinion here. You may follow it or not. You may accept it or not.’ It is very important to say this without raising your voice. Even the most bitter medicine is given in coated form, covered with sugar. Even the harshest truth must be expressed clearly but with an appropriate tone and proper style. One must be firm. In fact, in such situations at the hospital, we obtain a treatment refusal form. That means if the patient says, ‘I do not want this vaccine, I do not accept this treatment,’ this is possible. Because ultimately you are the patient’s guardian or representative, and you make the final decision. Starting with the phrase ‘The final decision is yours’ is very effective. The moment you say, ‘The final decision is yours,’ the other person thinks, ‘They are not dominating me, they are not pressuring me,’ and immediately becomes neutral. Trust is formed there.”

“Open, transparent, and accountable communication solves problems”

Pointing out that trust has weakened significantly in this era, Tarhan said, “Open, transparent, and accountable communication solves problems. The most important element in communication is trust. Unfortunately, trust has greatly weakened in this era. Yet the greatest capital is trust capital. The most valuable currency is honesty. Today, an honest and trustworthy person can accumulate capital. Therefore, one must establish an open, transparent, and honest relationship. When we speak of honesty, we must also distinguish something. There are forms of toxic honesty, and we do not advocate those. Some may ask, ‘Is there such a thing as toxic honesty?’ In the military, sometimes when one person in a unit makes a mistake, the entire unit is punished with crawling drills. This is applied for training and discipline purposes, but it is not fair. The aim there is for others to pressure that person so that it does not happen again. This habit comes more from autocratic societies and cultures of pressure. In open and transparent communication, however, one says, ‘There is such an application for these reasons,’ and it is discussed openly. That is why open communication is very important, without withholding or concealing information.”

The cause of all evil is lack of empathy

Emphasizing the importance of empathy in communication, Tarhan said, “Look at the books written about evil. There is a book by Baron titled The Psychology of Evil, which has also been translated into Turkish. I benefited greatly from it while working on my own book. Believe me, from beginning to end it explains empathy. If you were to gather all evils into one room, the door would be opened by lack of empathy. Not being able to understand the other person, not being able to understand their needs and feelings, not being able to see from their position. We also work on this in therapy. There is a technique called the empty chair method. For example, suppose the client has a problem with their mother. We say, ‘You sit here, this empty chair is your mother’s chair. Assume your mother is here. Say whatever comes to your mind.’ They speak. Then we say, ‘Now switch places and respond on behalf of your mother.’ This way they learn to look from their mother’s perspective. In other words, they learn empathy. The empty chair model. We also wrote about this in our book The Science of Happiness and Values. We use this method both as an empathy module and in the search for meaning. By replacing the incorrect meaning a person attributes to their behavior with a correct meaning, we can transform erroneous value judgments in the brain.”

“There should be no hopelessness in a physician’s vocabulary”

Stating that the best possible option should be offered to the patient, Tarhan said, “There should be no hopelessness in the vocabulary of a healthcare professional or physician. Our responsibility is to apply the methods that medicine offers us for the patient’s recovery. We apply them; the outcome may be good or not. We can only estimate. For example, after six months of treatment, we may expect a 60 to 70 percent improvement. Sometimes this rises to 80 or 90 percent; sometimes it remains at 30 percent. Therefore, one should not make definite promises to the patient. One can only present an estimate. For instance, in addiction patients, if treatment continues for six months, we can foresee a 60 to 70 percent improvement. If it does not continue for six months, the patient relapses. If they do continue, we truly achieve results. Impaired neuroplasticity in the brain can only recover in approximately six months. In such cases, what needs to be done is not to fall into hopelessness but to offer realistic hope. There is also unrealistic hope. For example, it is wrong to say about chronic schizophrenia, ‘It will never improve,’ just as it is wrong to tell a patient who has lost a leg, ‘I will make you a new leg.’ One must say, ‘I will work to provide you with the most suitable and best prosthesis, to find the most advanced and functional solution.’ Our duty is to research for the patient’s well-being and treatment and to strive to offer the best possible option.”

“A conflict unresolved in the mind is attempted to be resolved in the body”

Referring to the effects of unresolved traumas on the body, Tarhan said, “If a person cannot resolve a mental or emotional conflict, they begin to resolve it through body language. In other words, a conflict unresolved in the mind is attempted to be resolved in the body. A person begins to live in their body what they cannot solve mentally. When the brain cannot handle unresolved traumas mentally and emotionally, when a person cannot express their feelings through open communication or suppresses them, they then try to resolve them through bodily expressions. We describe it as follows: a person is psychologically wounded because of an issue they cannot resolve mentally. Their soul is wounded. How does this wound in the soul reflect on the body? We work on this with somatic experiencing therapies. For example, we guide the person through breathing exercises and, through methods similar to autogenic training, help them notice tension in their shoulders, neck, and back muscles. Fibromyalgia can emerge in this way. Stomach and intestinal problems are more common in angry individuals. In sad individuals, the immune system is more affected. This is not absolute, but generally in people who experience long-term depressive sadness, the immune system weakens. According to the literature, stress suppresses the immune system; we call this immunosuppression. When the immune system is suppressed, DNA damage increases and DNA repair is impaired. As a result, atypical, dormant cells begin to multiply and cancer may emerge. Sadness has a physiological counterpart. This is called concealed depression, somatized depression, or masked depression. In masked depression, the person does not appear depressed from the outside; they seem cheerful, lively, smiling, but there is a storm in their inner world, and they live it through their body language,” he concluded.

The talk ended with a group photo session.

Tarhan also signed his books for readers.

In the well-attended program, Tarhan took photos with his readers and chatted with them.